Air pollution and climate change have a significant impact on human health and well‐being and contribute to the onset and aggravation of allergic rhinitis and asthma among other chronic respiratory diseases. In Westernized countries, households have experienced a process of increasing insulation and individuals tend to spend most of their time indoors. These sequelae implicate a high exposure to indoor allergens (house dust mites, pets, molds, etc), tobacco smoke, and other pollutants, which have an impact on respiratory health. Outdoor air pollution derived from traffic and other human activities not only has a direct negative effect on human health but also enhances the allergenicity of some plants and contributes to global warming. Climate change modifies the availability and distribution of plant‐ and fungal‐derived allergens and increases the frequency of extreme climate events. This review summarizes the effects of indoor air pollution, outdoor air pollution, and subsequent climate change on asthma and allergic rhinitis in children and adults and addresses the policy adjustments and lifestyle changes required to mitigate their deleterious effects.

Inflammation, structural, and functional abnormalities within the airways are key features of asthma. Although these processes are well documented, their expression varies across the heterogeneous spectrum of asthma. Type 2 inflammatory responses are characterized by increased levels of eosinophils, FeNO, and type 2 cytokines in

Background:Inhaled corticosteroids (ICS) are the most widely prescribed and effec-

This study systematically reviewed and quantified the relationship between exposure to antibiotics during the first 2 years of life and the risk of allergies/atopies including hay fever, eczema, food allergy, positive skin prick testing (SPT), or elevated allergen-specific serum/plasma immunoglobulin (Ig) E levels later in life.PubMed and Web of Science databases were searched for observational studies published from January 1966 through November 11, 2015. Overall pooled estimates of the odds ratios (ORs) were obtained using fixed or random-effects models. Earlylife exposure to antibiotics appears to be related to an increased risk of allergic symptoms of hay fever, eczema, and food allergy later in life. The summary OR for the risk of hay fever (22 studies Early-life exposure to antibiotics has been related to some later life morbidities such as obesity, arthritis, asthma, and allergies. 6,7 A meta-analysis from 2006 showed a higher risk of asthma among those children exposed to antibiotics in early childhood. 8 However, a more recent meta-analysis from 2011 reported that the association between antibiotics exposure and subsequent development of wheeze/asthma was weak when the analysis was adjusted for reverse causation and confounding by indication. 9Several studies have suggested that early-life exposure to antibiotics is associated with an increased risk of developing allergies and atopies later in life, but results are inconsistent. Therefore, the aim of this study was to conduct a systematic review and meta-analysis to assess and quantify the relationship between early-life exposure to antibiotics and the risk of developing symptoms of hay fever, eczema, food allergy, positive skin prick testing (SPT), or elevated allergen-specific serum/plasma immunoglobulin (Ig) E levels later in life.Abbreviations: CI, confidence interval; HR, hazard ratio; IgE, immunoglobulin E; OR, odds ratio; SPT, skin prick test.

Asthma is the most common chronic disease in children, and is characterized by airway inflammation, bronchial hyperresponsiveness, and airflow obstruction. Asthma diagnosis, phenotyping, and monitoring are still challenging with currently available methods, such as spirometry, F NO or sputum analysis. The analysis of volatile organic compounds (VOCs) in exhaled breath could be an interesting non-invasive approach, but has not yet reached clinical practice. This review describes the current status of breath analysis in the diagnosis and monitoring of pediatric asthma. Furthermore, features of an ideal breath test, different breath analysis techniques, and important methodological issues are discussed. Although only a (small) number of studies have been performed in pediatric asthma, of which the majority is focusing on asthma diagnosis, these studies show moderate to good prediction accuracy (80-100%, with models including 6-28 VOCs), thereby qualifying breathomics for future application. However, standardization of procedures, longitudinal studies, as well as external validation are needed in order to further develop breathomics into clinical tools. Such a non-invasive tool may be the next step toward stratified and personalized medicine in pediatric respiratory disease.

Background The Gly-to-Arg substitution at the 16 position (rs1042713) in the beta 2 adrenoceptor (ADRB2) gene is associated with enhanced down-regulation and uncoupling of beta-2 receptors. Objectives To undertake a meta-analysis to test the hypothesis that there is an interaction between the A allele of rs1042713 (Arg16 amino acid) and long acting beta agonist (LABA) exposure for asthma exacerbations in children. Methods Children with diagnosed asthma were recruited in five populations (BREATHE, GALA II, PACMAN, PAGES and PASS). A history of recent exacerbation and asthma treatment were determined from questionnaire data. DNA was extracted and the Gly16Arg genotype determined. Results Data from 4226 children of white Northern European and Latino origin were analysed and the odds ratio for exacerbation increased by 1.52 [1.17, 1.99] p=0.0021 for each copy of the A allele among the 637 children treated with inhaled corticosteroids (ICS) plus LABA but not for treatment with ICS alone (n=1758), nor ICS plus leukotriene receptor antagonist (LTRA, n=354) or ICS plus LABA plus LTRA (n=569). Conclusions The use of LABA as “add-on controller”, but not LTRA, is associated with increased risk of asthma exacerbations in children carrying one or two A alleles at rs1042713. Prospective genotype stratified clinical trials are now required to explore the potential role of rs1042713 genotyping for personalised asthma therapy in children.

To estimate the association between obesity and poor asthma control or risk of exacerbations in asthmatic children and adolescents, and to assess whether these associations are different by sex.A meta-analysis was performed on unpublished data from three North-European paediatric asthma cohorts (BREATHE, PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) and PAGES (Pediatric Asthma Gene Environment Study)) and 11 previously published studies (cross-sectional and longitudinal studies). Outcomes were poor asthma control (based on asthma symptoms) and exacerbations rates (asthma-related visits to the emergency department, asthma-related hospitalisations or use of oral corticosteroids). Overall pooled estimates of the odds ratios were obtained using fixed- or random-effects models.In a meta-analysis of 46 070 asthmatic children and adolescents, obese children (body mass index ≥95th percentile) compared with non-obese peers had a small but significant increased risk of asthma exacerbations (OR 1.17, 95% CI 1.03-1.34; I: 54.7%). However, there was no statistically significant association between obesity and poor asthma control (n=4973, OR 1.23, 95% CI 0.99-1.53; I: 0.0%). After stratification for sex, the differences in odds ratios for girls and boys were similar, yet no longer statistically significant.In asthmatic children, obesity is associated with a minor increased risk of asthma exacerbations but not with poor asthma control. Sex does not appear to modify this risk.

Children treated with antibiotic in the first 3 years of life are more likely to develop asthma, but there is no evidence that the exposure to antibiotic is associated with increased risk of asthma exacerbations.